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F, B, H, G

• B (CN VI): lesion results in the atrophy of the ipsilateral lateral rectus

• F (V1): lesion results in the loss of the direct and indirect corneal reflex upon stimulation of the ipsi cornea
• G (ACA): supplies part of the primary motor, primary sensory and supplementary motor cortex
• H (pons): supplied by basilar artery; lesion of the corticobulbars at the brain stem level indicated by H would interrupt corticobulbar fibers to motor V, motor VII, nucleus ambiguus and the hypoglossal nucleus 

inappropriate words
articulation ok

Wernicke's (LEFT parietal and temporal cortex surrounding dorsocaudal region of lateral fissure)

Um…(sighs)…um…(sighs)…left…(gestures to the right side of the body)…right side…(shakes head and sighs)

Broca's aphasia

first patient was Tan and all he could say was Tan, Tan, Tan....

When I grew up in the army, this was my whole fife, lar…light.  I was in the army, the army, and the war and everything else under the sun.

Wernicke's aphasia

comprehension bad

speech is fluent

You are interviewing a patient, who had a stroke several years ago, and her husband. The husband reports that recently at a family party his wife denied he was present even though he was standing nearby. She has no visual deficits and fairly well preserved intelligence. What condition may she have?

hemispatial neglect

if ask to draw a clock will leave out 6-12 o'clock or put 1-12 all on the right

• are called the fusiform gyri, and lesions result in prosopagnosia
• patient with bilateral lesions can not "bring her face back into her mind's eye."
• millions of people may be face-blind

• assuming she has a visual agnosia, if she also had a lesion of the dorsal columns on the right side of her rostral spinal cord, or her left VPL, or her left areas 3, 1, 2, she would not be able to identify the object as keys via touch

• assuming she only has a visual agnosia, she would be able to identify the keys as keys if she jangled them

a patient who can draw the three objects shown above  but can NOT choose the odd object from the three has an associative visual agnosia

a patient with apperceptive agnosia would not be able to determine...

• that the lower object view in A is a pail

• all of the types of fruit in the left figure of B

• that the figure is C is part of a cow

• if the patient cannot do any of the above 3 tests, he/she won't be able to copy either

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is a branch of ... and occlusion results in...

a branch of the internal carotid and occlusion can result in a deficit in planning

left anterior cerbral artery

• one of the arteries has branches called the central retinal and posterior ciliary arteries

• one of the main arteries has divisions that feed Broca's and Wernicke's areas

• the angiogram shows the internal carotid, middle cerebral, anterior cerebral, and anterior choroidal arteries

(none is true)

correct answers:

• B is the ACA (occlusion of the right MCA results in contralateral neglect)
• D is the AICA
• damage to dorsal midbrain = damage to superior colliculi
• E is the posterior communicating artery

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• the cortical area that receives thalamic input from the anterior nucleus of the thalamus can be seen in this view of the brain 

• [image]

damage of E (ossicles)will result in a Rinne test that reveals bone conduction better than air conduction in the ipsi ear

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B, C, F, G

• B is the thalamus (medial geniculate) and it receives a blood supply from branches of the posterior cerebral artery (PCA)
• C (optic tract): contralateral homonymous hemianopia
• F (CN V) and G (CN VIII): lesions (at the same time) will result in the loss of the direct corneal reflex on the same side as the direction of stumbling 

a lesion of the nerve F (CN V3) will result in ipsilateral deviation of the jaw (ummmmmmmm bad!!) upon jaw opening

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C, E, F

• F (CN III): lesion = light shown into the ipsilateral eye will result in constriction of only the contralateral pupil
• E: parahippocampal gyrus, underneath which lies the hippocampus, better known as the "memory maker." The hippo is supplied by the PCA
• C: sole source of climbing fibers to the cerebellum; they are involved in motor learning

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occlusion of ... will result in ...

occlusion of H on the left side will result in Wernicke's aphasia

cingulate gyrus

receives input from anterior nuclei of thalamus

mammillary body

• bilateral lesions of structures and area dorsal to them results in hypothermia
• receives input from the fornix
• projects to the anterior nucleus

• hyperphagia
• loss of fear
• hypersexuality
• bilateral damage to amygdala

ventromedial nucleus of the hypothalamus

cells targeted by leptin released by adipocytes, lesions result in hyperphagia

lateral hypothalamic area

lesion results in patient not eating enough

supraoptic nucleus

cells produce vasopressin

cell axons to posterior pituitary

cells produce oxytocin

paraventricular nucleus

cells produce oxytocin

arcuate nucleus of hypothalamus

• cells secrete releasing factors
• controls the release of numerous hormones from the anterior pituitary

cingulate cortex--middle cerebral artery

(correct: anterior cerebral artery)

caudal (or posterior) hypothalamus--regulates temperature by dissipating excess heat

(correct: prevents hypothermia)

• cells indicated by B (mammillary bodies) are targeted by cells in the hippocampus via fornix
• cells in structures indicated by B project to the anterior nuclei of the thalamus via MTT

A = cerebral peduncle; lesion=contra weakness below the eyes due to corticobulbar damage

• initial contralateral hemianesthesia
• motor problems which mimic basal ganglia or cerebellar dysfunction
• homonymous hemianopsia
• increased sensitivity to painful stimuli

VA/VL thalamic nuclei

• cells receive input from lenticular fasciculus
• cells receive input from ansa lenticularis
• cells project to motor-related cortical areas
• cells receive input from the cerebellum

lateral geniculate body

contains map of contralateral visual hemifield (half-field)

• B is the uncus
• cells in C (mammillary body) project to the anterior nuclei of the thalamus via the MTT

A = olfactory tract

lie in the tuberal area of the hypothalamus and, in particular, in the lateral hypothalamic area

once the leptin from the fat cells in the top mouse is released, it can turn off cells in the lateral hypothalamic area

blood supply of...

olfactory tract and anterior perforated substance

blood supply of...

rostral and medial part of parahippocampal gyrus (uncus)

blood supply of...

parahippocampal gyrus and underlying hippocampus

blood supply of...

primary olfactory cortex

patient S had bilateral calcification of the starred structures and it was as if  negative emotions such as fear and anger had been removed from her affective vocabulary

• C (internal capsule) receives a dual blood suppy, anterior choroidal and lateral striate
• the lesion in B (whitish area), which is in VPL/VMP, can lead to allodynia, hyperalgesia and hyperpathy on the contalateral side of the body and head

aneurysm (dilation) of the left posterior cerebral artery near its origin from the basilar artery

• pressure on CN III that results in a dilated pupil in the left eye (efferent defect)
• pressure on CN III that results in diplopia
• if it bursts, there will be blood in the subarachnoid space

• patient could have a lesion in the left ciliary ganglion
• if the patient has a lesion of only CN III, alternating your pen light quickly between the two eyes will result in the right eye maintaining a constant diameter
• if the upper lid is closed, the patient will not have diplopia

fiber bundle A terminates in the mammillary body, which is part of the  hypothalamus where lesions result in hypothermia

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K contains axons that arise from the Edinger-Westphal nucleus; as these axons exit the midbrain they pass just medial to the cerebral peduncles, which contain corticospinal and corticobulbar fibers; damage at this spot would result in an ipsilaterally dilated pupil and contralateral hemiplegia

the fibers at A can be seen exiting he midbrain at the level of the superior colliculus; they will exit the dura in the posterior cranial fossa and enter the superior orbital foramen in the middle cranial fossa

C shows "Kernohan's notch," which Big John failed to mention when discussing Case 1.  It is the result of the uncal herniation on the contra side pushing the cerebral peduncle into free edge of the tentorium cerebelli.  This damages corticospinal fibers in this peduncle and when added to the damage to the cerebral peduncle on the side of the herniation results in quadriplegia

some axons in H are preganglionic parasympathetics from the Edinger-Westphal nucleus; some axons in H are somatomotor

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The top  brain section is from a normal brain while the bottom section is from the brain of a patient afflicted by a neurodegenerative disease.  Which of the following atatements is/are TRUE regarding the disease/patient etc  associated with the bottom brain slice?  

Parkinson's

• micrographia
• deficit could be improved via a lesion of the subthalamic nucleus
• resting tremor
• could be helped by smoking (dopamine)
• could have spasticity

a Lewy body, which is a cellular inclusion seen in substantia nigra neurons in Parkinson's disease

[image]

The photo on the left is a slice from a normal brain, while the one on the right is from a brain with a neurodegenerative disease. Which of the following statements is/are TRUE regarding the patient, the disease, or the brain slice?

increase in length of CAG triplet

(Huntington's)

[image]

The photo shows a "blue spot" that is not blue!  That is, the structure does not have a normal amount of NE producting  cells.   Which of the following could account for this?

[image]

The photo shows considerable atrophy of the prefrontal lobes.  Which of the following statements is/are TRUE regarding this cortical region or the disease that caused the atrophy?

Huntington's dementia and depression

• receives input from the mediodorsal nucleus of the thalamus
• receives blood supply, at least in part, from the middle cerebral artery
• has resulted from a disease that also results in atrophy of cells in the caudate that project to the GPe
• patients often have seizures and disease associated with chromosone 4

• persons begin with piano playing movements of the fingers or with slight facial twitching
• movements gradually becomes uncontrollable
• speech become incomprehensible and swallowing is difficult
• individuals lose the ability to communicate and are improperly nourished

D is the middle cerebellar peduncle; it contains pontocerebellar fibers that arise from contralateral pontine grey cells; a lesion in the MCP results in ipsilateral incoordination 

* indicates the globus pallidus; all cells in this nucleus, which has two divisions, are inhibitory 

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• A is the caudate
• B is the thalamus 
• C is the putamen
• the blood supply to D is part of the vertebral-basilar system
• the arrows at E show the fornix, which connects the hippocampus and mammillary body
• F is the lateral ventricle
• the cell bodies of axons in G lie in the ipsilateral lateral geniculate body
• H points to where the anterior cerebral artery runs; occlusion of this artery results in many FEWER symptoms and deficits than occlusion of the midddle cerebral or posterior cerebral arteries
• some of the blood supply to I arises from the ophtalamic artery, which is a branch of the internal carotid artery and enters the orbit via the optic foramen

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The lesion (white zone) indicated by the arrow lies in the intermediate zone of the cerebellum. Which of the following statements is/are TRUE?

there would be right side incoordination, right intention tremor, right dysdiadochokinesia, right dysmetria; zone receives pontocerebellar fibers

• A is basilar artery, part of vertebral basilar circulation
• B is the fourth ventricle
• C lies in the basilar pons and a lesion of the corticospinal fibers in this region will result in an extensor plantar resonse in the contralateral big toe
• D is the facial colliculus

• a lesion of the superior cerebellar peduncle at B results in contralateral movement (intention) tremor
• a lesion of the superior cerebellar peduncle at A results in ipsilateral dysdiodochokinesia
• the cell bodies of SCP fibers at B lie in the contralateral nucleus interpositus
• the cell bodies of SCP fibers at A lie in the ipsilateral  nucleus interpositus

• a lesion of the MLF  at B will result in the inability to turn the right eye medially upon trying to move both eyes to the left
• the MLF at A lies just dorsal to the decussation of the superior cerebellar peduncle
• the MLF at B is at the same pontine level as the motor V and chief sensory V

• a  lesion of A will result in contralateral hemiplegia; a bleed from either the lateral striate arteries or the anterior choroidal artery could cause the lesion
• E is the insular cortex; Dave talked about it as a place where taste and olfacoty information comes together

E is called the coronal radiata; it is an area of fibers just under the cells in cortex where axons are descending into the internal capsule

• the left eye can not move medially when attempting to look to the right; it can move medially (adduct) upon convergence 
• the right eye can not move medially when attempting to look to the left  
• there is a  lesion in the left abducens nucleus that includes its LMNs, its interneurons that project rostrally up the contra MLF, and the MLF fibers that have arisen from the contra abducens nucleus
• the syndrome is called one and one-half!
• the reason that the patient can converge is that a "convergence center" that lies rostral to the oculomotor complex projects to medial rectus neurons in both oculomotor nuclei 

frustrations with language expression often result in curses, comprehension of language is relatively intact, can have right-sided hemiplegia, blood supply is middle cerebral

Broca's aphasia

[image]

lesion of Broca's area

• the study of aphasia began with Broca's original case reports of 1861. The first patient could only utter the phrase "tan".
• writing is affected. Although the patient with Broca's aphasia typically has right-sided hemiplegia, their writing disorder extends beyond simple motor incoordination or weakness. Their language production through writing is similar to language production through speech.
• the patient understands oral communications from others, and reading may be normal

[image]

The white arrows point to the VPM (lighter  stained area) and VPL (darker stained area).

the lesion could result from damage to a  branch of the posterior cerebral and/or the posterior communicating arteries; damage to some cells that project to the insular cortex  

the browish mammillary bodies suggest that this patient had Korsakoff's psychosis/syndrome; the patient probably had memory problems like HM ( who lost both of his hippocampi; A) but also made up stories to conceal the deficit (confabulation)

• a lesion of all axons at J will result in atrophy of all muscles of facial expression, the stylohyoid muscle and the posterior belly of the digastic; such a lesion will also result in loss of taste from the anterior two-thirds of the ipsilateral side of the tongue and interruption of preganglionic parasympathetic axons that comprise the greater petrosal nerve  
• axons at  C will pass through the parotid gland to reach the muscles of facial expression; if  H is broken while scuba diving on a Hoofers trip to Barbados, then a tuning fork placed in the middle of the patient's head/skull will be perceived as louder in  his/her ear ipsi to the damaged  membrane

area supplied at least in part by posterior inferior cerebellar artery (PICA)

Wallenberg, lateral medullary syndrome=PICA=classic NB

[image]

The lesion indicated by the white arrow would result in:

(do you recognize level 3?)  THIS IS  A PICA BLOWOUT!!!!!

• ipsilateral loss of pain and temp from the face
• absence of a consensual gag reflex upon stimulation of the right side of the pharynx

[image]

occlusion of the artery on the ventral surface of the T4 spinal  level will result in...

atrophy of the muscles innervated by LMN at spinal level T4

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loss of pain and temperature from T6 and below

the artery on the ventral surface of the spinal cord at T4 is a branch of the vertebral artery

[image]

lesion at C causes...

• ipsi loss of corneal reflex upon stimulation of either cornea (due to loss of motor VII)
• ipsi loss of facial expression
• hyperacusis